Conducting implementation science

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Published: 8 May 2019
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Dr Marilyn Hammer - Mount Sinai, New York, USA

Dr Marilyn Hammer speaks to ecancer at ONS 2019 about the importance of implementation science and how it can be achieved. 

She explains the concept of implementation science and how it is focused on improving patient care in terms of quality of life, prevention and survivorship. She stresses that dissemination of information is crucial and explains the importance of taking cultural needs of patients in to account.

Dr Hammer concludes by describing some of the challenges to implementation science and how these can be overcome.

The session was on implementation science, bridging research to practice. I had the privilege of facilitating the session and we talked about all aspects of how to conduct implementation science. We talked about using the INSPIRE model, the definitions of nursing science and implementation science. We got into a robust discussion at the end with the audience about the dissemination piece of it which is so important. Once we conduct studies it’s so important to make sure that the information is not only implemented but disseminated so that others can also implement it so that we reach more patients far and wide.

How do you define implementation science and why is it important to nurses?

It’s defined a number of ways. The textbook definition is the study of the methods that take research and implement them into practice. It’s so important because it’s what creates the evidence for practice. We conduct the research studies, we find the evidence for whether it’s investigational or implementing a type of intervention, but the important part is how does that really impact patients. Really it’s all about the patients, about patient care, quality of life, prevention, survivorship issues and, of course, overall survival is always the goal with patients with cancer. Then in the future looking toward prevention and eventually if we can prevent everybody from becoming patients that’s the ultimate goal.

But for implementation science it’s finding those answers to those rich research questions and then taking that to the next level, getting to not just test it in a small cohort of patients but disseminate it throughout a much larger population so that we are making a real change in practice.

In what ways can it be disseminated?

The dissemination part of it is like being at this meeting – you give presentations, publications are a huge part of that. You can do it small scale internally – a lot of times within our institutions we’ll disseminate locally from unit based or institution based but then the large scale dissemination really comes in the form of the publications and then going to these types of meetings and presenting and networking and sharing the information with each other. It’s essential to share what we learn and that’s a large part of the whole data science and the Moonshot Initiative and everything that’s going on in the world of genetics and genomics.
The large databases that contain information or the data from multiple studies that then can be compositely investigated, so it’s another form of dissemination by sharing this information and then looking for common data elements so that we can get a much better picture of different people and different cultures so that it really comes down to that tailored care. We talk about precision medicine, precision health and this is all part of how we get there and the dissemination part is just really essential for that. One of the large initiatives that’s really now in its second year is the All Of Us initiative out of the National Institutes of Health. That is a goal to enrol over a million patients worldwide so that we capture every culture and every background from both genetic and epigenetic areas so we can get the phenotypes as well as the genotypes and really understand who we are as a population so much better. That type of large thinking, that type of collaborative research, is where you could say the rubber meets the road, where we get to the point of care where we make huge impacts in our population at large.

Can you explain more about the INSPIRE model?

The INSPIRE model was developed by Gwen Wallen from the NIH Clinic Centre and it’s a really nice algorithm that helps you differentiate between whether you need to conduct a research study, an evidence-based practice project or a quality improvement project. So if there’s a need, let’s say, on a unit or for a certain patient need, you can look through the literature or ask your colleagues and see are you using the most current evidence-based practice in this area. If you are but it’s not working right and something needs to be adjusted then you need to conduct a quality improvement project. If you’re not using the most current evidence-based protocol but there is evidence out there in the literature for it, or in other areas or guidelines, you incorporate that into your practice and evaluate it, that would be an evidence-based practice project. If there isn’t and you need to create new knowledge then that is a research study. So the INSPIRE model helps you to decipher, going through this algorithm, of what type of project or study you need to conduct based on your question or your need for whatever patient issue comes up. It’s a beautiful model and I think that it’s something that everybody should use in this area. It fits so nicely with implementation science because it does cover the whole gamut from research to practice.

What is your take home message for oncology nurses?

There were certain pearls that did come out of the session. One was on cultural humility, so really being respectful of different cultures around the world, different patient needs as you do these implementation science studies. It’s not just about being rote in what you believe in but really hearing the voice of the patient and engaging with the patient.

The basic overall take homes really were about hearing the patient’s voice, I think that was probably the biggest take home, being culturally sensitive and just having a lot of integrity in everything you do and making sure that there’s clinical meaningfulness at the end of the road.

It’s a complex field, implementation science, as any area is. It is, again, the study of the methodology so there are many different approaches to it. There’s that dissemination piece again that we spoke about. One way to get there is thinking about pragmatic research which is real life research – people in their natural settings. That’s needed because when we do things that are more very structured and laboratory based it doesn’t always translate to the real life setting. So a lot of those pearls came out of the session and, again, it was a lot of fun, it was thought-provoking and I think we all got a lot out of it.

There were some thoughts that we don’t do enough as nurses, as nurse scientists, in not just the implementation science area. We did talk about the fact that the funding for translational research through the national centre, it’s called NCATS, for translational research, very few nurses actually tap into that funding mechanism yet if you look at nursing science, which is so holistic in nature, and implementation science which runs that gamut from research to practice nurses are well positioned to be the ones to conduct these types of studies, to be the leaders of these types of studies yet we don’t have a lot of the funding for that. We have a small portion of it so I think that we need to look to this area a little bit more. We need to throw in more grant applications so that we can conduct more of these studies because we are really well positioned as nurse scientists to do this.

There’s going to be a belief, a grant mechanism through the ONS Foundation for implementation science coming up so stay tuned for that.